Stake a Claim: Applying Claims Procedures in ERISA Plans

If an ERISA plan participant has a claim against the plan fiduciaries, the participant first must exhaust the plan’s internal remedies. Once the participant makes their claim, the plan administrator must prepare and deliver a written notice of the benefits denial with specific reasons laid out. The participant may appeal that decision and, if so, must receive "a full and fair review" of that decision. If benefits remain denied, the employee may then bring the claim in federal court.

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Related Content

• ERISA Claims Review Procedures Process Map (General Rules)
  Reference this process map providing an overview of the key stages of the life cycle of a typical claim for benefits made by a participant or beneficiary in an ERISA employee benefit plan.
• ERISA Claims and Litigation Resource Kit
  Learn more about claims and litigation in the benefits arena. This resource kit includes documents regarding ERISA litigation, claims procedures, self-correction and agency-correction programs, and agency (DOL and IRS) plan investigations.

Practical Guidance Updates 
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• Employee Benefits & Executive Compensation Key Legal Developments Tracker (Current)
  Stay informed on new developments.
  • ERISA Litigation. In a unanimous decision written by Justice Sotomayor, the U.S. Supreme Court revived a class action from Cornell University workers who said their retirement plans were burdened by excessive fees, finding that the Second Circuit had overreached when it shut down the case. Cunningham v. Cornell Univ., 2025 U.S. LEXIS 1458 (Apr. 17, 2025); Justices Revive Cornell Worker’s ERISA Fee Suit.
  • Retirement Plans. DOL releases guidance addressing compliance questions on SECURE 2.0 Act’s required changes to annual funding notices (AFNs) under ERISA Section 101(f). The guidance includes two updated model AFNs. Field Assistance Bulletin 2025-02.
  • Health and Welfare Plans. IRS publishes the 2026 inflation adjusted amounts for Health Savings Accounts (HSAs) under R.C. § 223and the maximum amount that may be made newly available for excepted benefit health reimbursement arrangements (HRAs) provided under Treas. Reg. § 54.9831-1(c)(3)(viii). HSA contributions rise to $4,400 in calendar year 2026, for self-only coverage, and $8,750 for an individual with family coverage under a high-deductible health plan.
  • Executive Compensation. The DOL’s Wage and Hour Division advised it will cease to enforce the Biden administration’s rule defining the term “independent contractor” under the Fair Labor Standards Act (FLSA) (which aimed to reclassify gig workers as employees rather than independent contractors) instead relying on criteria set forth in a DOL 2008 Fact Sheet.Field Assistance Bulletin No. 2025-1; News Release.
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